Thoracic Gunshot Wound Research Articles

Impact of Postoperative Imaging Following Emergency Surgery for Penetrating Ballistic Thoracic Trauma.

Patients undergoing emergent surgical procedures after penetrating trauma can benefit from postoperative imaging studies to identify potential missed injuries or indications to additional surgery. Aim of this study is to describe postoperative imaging findings in patients who underwent emergent operation for thoracic gunshot wounds (GSWs) and the subsequent need for further surgery, diagnostic evaluations or consults. Patients who survived to receive imaging evaluation after emergency surgery for penetrating chest trauma in a level I trauma center between 2017 and 2021 were included. Results of postoperative diagnostic evaluation were screened to determine their impact on the subsequent management. Overall, 125 patients admitted with a thoracic GSW underwent an emergent surgical procedure and 29 survived to receive postoperative imaging and were included. Postoperative CT-scan was performed in 26 (89.6%) patients, echocardiography in 8 (27.5%). Other tests included esophagoscopy (1) and bronchoscopy (1). Impact on management of abnormal imaging included a new indication to surgery or additional procedures in 7 cases and need for additional imaging or consults in other 8 cases. Bone fractures and lung injuries were more often diagnosed on postoperative CT-scan. In 3 patients, abnormal echocardiographic findings led to a second cardiac operation. Following emergency surgery for penetrating trauma, completion of injury assessment with CT-scan can lead to identification of missed or additional injuries, while other imaging is indicated according to operative findings. In this study, 24.1% had additional surgical pathology identified by postoperative imaging while others had findings requiring additional studies or specialist consult evaluations.

Relationship of Obesity and Severe Penetrating Thoracic and Abdominal Injuries in Adolescent Patients.

Over 20% of United States adolescents are obese. A thicker layer of subcutaneous adiposity might provide a protective "armor" layer against penetrating wounds. We hypothesized that adolescents with obesity presenting after isolated thoracic and abdominal penetrating trauma have lower rates of severe injury and mortality than adolescents without obesity. The 2017-2019 Trauma Quality Improvement Program database was queried for patients between 12 and 17 years old presenting with knife or gunshot wounds. Patients with body mass index (BMI) ≥30 (obese) were compared to patients with BMI <30. Sub-analyses were performed for adolescents with isolated abdominal trauma and isolated thoracic trauma. Severe injury was defined as an abbreviated injury scale grade >3. Bivariate analyses were performed. 12,181 patients were identified; 1603 (13.2%) had obesity. In isolated abdominal gunshot or knife wounds, rates of severe intra-abdominal injuries and mortality were similar (all P > .05) between groups. In isolated thoracic gunshot wounds, adolescents with obesity had a lower rate of severe thoracic injury (5.1% vs 13.4%, P = .005) but statistically similar mortality (2.2% vs 6.3%, P = .053) compared to adolescents without obesity. In isolated thoracic knife wounds, rates of severe thoracic injuries and mortality were similar (all P > .05) between groups. Adolescent trauma patients with and without obesity presenting after isolated abdominal or thoracic knife wounds had similar rates of severe injury, operative intervention, and mortality. However, adolescents with obesity presenting after an isolated thoracic gunshot wound had a lower rate of severe injury. This may impact the future work-up and management of adolescents sustaining isolated thoracic gunshot wounds.

Bullet trajectory detection in the lung: Multiplanar reformatted imaging of multidetector computed tomography in children.

Trauma is a leading cause of childhood injuries. Although blunt traumas in children are more common in penetrating traumas, children in civilian life and near conflict areas can often be affected by gunshot wounds. Among all gunshot wounds, thoracic injuries constitute a significant proportion. In our study, we detected bullet trajectory in children with gunshot wounds penetrating the thorax by analyzing reformatted images of multidetector computed tomography (CT). Nineteen pediatric patients with thoracic gunshot wounds were evaluated retrospectively. After all patients admitted the emergency service, their hemodynamics were stabilized first. Then, PA-AC radiography and thorax CT were taken and necessary imaging studies of other body parts were performed. CT scans were performed with multi-detector CT. Using reformatted axial, sagittal, and coronal and oblique images of multidetector CT, we detected projectile trajectory in the lung parenchyma in 74% of patients. In 26% of the patients, the projectile trajectory could not be detected due to excessive parenchymal hemorrhage, hemothorax, and pneumothorax. In our study, a standard could not be made due to the fact that the types of weapons used could not be determined, the firing distances could not be known, different ages and different bullet entry and exit angles. However, detecting the trajectory of the bullet in the lungs will assist the physician in making the treatment plan and following up the patient. In addition, the evaluation of the data obtained will be beneficial to forensic medicine physicians and scientists interested in wound ballistics.

Demographics, Radiological Findings, and Predictors of Prolonged Hospitalization in Civilian Gunshot Wound Patients.

This study aims to characterize the demographic, clinical, and radiological features of gunshot wound (GSW) patients as well as identify predictors of prolonged hospitalization. In this retrospective study, a consecutive sampling method was used, including all patients with GSWs in any anatomical region. Data collection included demographic and clinical information, radiological findings, treatment specifics, and outcome variables, such as hospitalization length of stay (LOS) as the primary outcome. To identify predictive factors associated with prolonged LOS, logistic regression analysis was used. We studied 212 GSW cases, including 95.8% were men and 4.2% were women. The mean age of the studied group was 30.17±7.80 years. GSWs occurred in extremities (80.2%), abdomen (9.0%), thorax (4.7%), and head or neck (5.2%). Two patients (0.9%) had both abdominal and thoracic GSWs. The most prevalent radiological study was an X-ray (83.0%). Patients with head and neck GSWs had the longest emergency department stay, while patients with abdominal GSW patients had the shortest (p=0.068). The highest rates of blood product transfusion were observed in abdominal GSWs (63.2%), emergency surgery (63.2%), and ICU admission (42.1%). Head and neck GSWs had the longest hospitalization LOS (7.5 days). Longer LOS was significantly associated with abnormalities in radiological findings, receiving blood products, and ICU admission (p≤0.001). Significant predictors of prolonged LOS were major abnormalities in radiological findings [odds ratio (OR)=5.3; 95% confidence interval (CI):2.8-10.2], head and neck GSWs (OR=6.1; 95% CI:1.2-31.9), and blood product transfusion (OR=4.1; 95% CI: 1.0-16.3). This study provides insights into factors influencing prolonged hospitalization in GSW patients, highlighting the importance of radiological findings, head and neck injuries, and blood product transfusion.

Scientifi c Research of the SI “Institute of Nuclear Medicine and Diagnostic Radiology of the National Academy of Medical Sciences Of Ukraine” in 2021: Artifi cial intellect and postprocessing

Researchers of the Institute performed the applied scientific research "To develop technology for digital processing of radiological diagnostic images based on elements of artificial intelligence in diffuse liver pathology in patients of different ages" (funded from the budget of NAMS of Ukraine) in conjunction with SI "Academician O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the National Academy of Medical Sciences of Ukraine ” together with the National Technical University of Ukraine “Igor Sikorsky Kyiv Polytechnic Institute ». When performing research, the most important results are: investigations in patients with nonalcoholic fatty liver disease demonstrated that the modern algorithm of radiological examination allows to determine not only the features of the structural structure of the body in the age aspect, in particular to characterize the fat component and information on the acoustic stiffness of the parenchyma, but is an important prerequisite for further monitoring of the effectiveness of diffuse liver disease treatment; methods for rapid diagnosis of diffuse liver disease based on the artificial intelligence elements application have been developed and implemented into the examination algorithm, which improves the level and speed of liver disease diagnosis at the stages of primary examination by 30% and allows to develop a differentiated approach in the application of other (high-cost) methods of radiological diagnostics. Protocols for post-processing of pancreatic diseases were developed together with the SI " O.O. Shalimov National Institute of Surgery and Transplantology of the National Academy of Medical Sciences of Ukraine”. Scientists of the Institute together with the Ukrainian Military Medical Academy took part in the development of the complex of radiological methods for the diagnosis of thoracic gunshot wounds, visualization of wound canals in case of gunshot and mine-explosive injuries.

Military thoracic gunshot wounds: A systematic review

Abstract A systematic review of the literature was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method to investigate the frequency of military thoracic gunshot wounds (GSWs) and deaths in combat theatres since World War Two (WW2). An electronic database search of World of Science, Scopus, Science Direct, PubMed and Microsoft Academic was conducted using the keywords ‘combat, casualties, thorax, gunshot, and military’ to identify peer-reviewed journals and conference papers on the topic. Twenty-three sources relevant to this review were identified and covered multiple theatres of operation. While there is a downward trend in the frequency of thoracic GSWs and fatalities likely due to the improvement of body armour, the improvement in medical treatment and increased frequency of improvised explosive devices (IEDs), the review shows that the advancement has not removed the likelihood of thoracic GSWs, which still accounted for approximately 15% of all thoracic injuries in the most recent combat theatres. The systematic review identifies that GSWs of the thorax continue to be a risk in military theatres and therefore, medical personnel should be aware of the frequency and severity of thoracic GSWs and should be prepared to treat these life-threatening injuries, as timely intervention is essential.

Thoracic Gunshot Wound with Vascular Lesion

Abstract: The thoracic gunshot wounds may cause high morbidity and mortality, especially if accompanied by vascular injuries. Therefore, immediate management and precise decision are needed. A 35-year-old man who was referred from the regional hospital presented with thoracic gunshot wound and a history of hemorrhagic shock. A projectile was found through the chest wall and caused axillary artery rupture. The patient underwent exploratory thoracotomy and axillo-brachial artery bypass using a great saphenous vein graft. The patient's postoperative condition showed improvement in hemodynamic and distal limb perfusion. Keywords: Chest trauma, gunshot wound, axillary artery, vascular injury

Radiation diagnostics of thoracic gunshot wounds

The frequency of thoracic injuries in the general structure of combat surgical trauma remains at the level of 7-12 % and unchanged from the time of the Second World War to the current armed conflicts. The overwhelming majority of them (up to 72 %) are shrapnel gunshot wounds. The formation of a gunshot wound occurs due to the action of a shock wave; a wounding projectile; energy of side impact and vortex wake. The shape, size, features of the wound canal are determined by the kinetic energy of the wounding agent and the physical properties of the damaged tissues. The lung parenchyma is loose and elastic, so small-caliber bullets with low energy cause minimal damage. The wound canal is well differentiated on CT-slices. Its cavity is filled with blood, fragments of destroyed tissue, air bubbles. On the periphery, the contusion zone is determined (area of increased attenuation in the lung-ground-glass opacity). Shrapnel wounds can be accompanied by ruptures of the pulmonary parenchyma with hemorrhages, bilateral pulmonary contusion, damage to the bone frame and soft tissues of the chest. Vascular injury with massive hemorrhage into the pleural cavity and tense hemopneumothorax are one of the main causes of mortality in penetrating wounds. Transmediastinal gunshot wounds, armor trauma and bullet embolism require special attention during radiation examination of victims. The purpose of radiation diagnostics of modern combat trauma is to identify and fully characterize injuries and their complications. The amount of diagnostic information is determined by the level of medical care. Key words: gunshot wounds, chest cavity organs, radiation diagnostics.

The Success of ECMO in Flail Chest and ARDS Following Thoracic Gunshot Wound

The Success of ECMO in Flail Chest and ARDS Following Thoracic Gunshot Wound

Operative Management of Thoracic Gunshot Wounds: More Aggressive Treatment Has Been Required over Time

Our department has a database of thoracic gunshot wounds (GSWs), which has cataloged these injury patterns over the past five decades. Prevailing wisdom on the management of these injuries suggested operative treatment beyond tube thoracostomy is not commonly required. It was our clinical impression that the operative treatment required beyond chest tube placement has greatly increased over the past several decades, whereas the operative management of cardiac GSWs seemed to be increasingly infrequent events. To test these observations, we analyzed the treatment of GSWs to the chest and heart in four distinct time periods, categorized as "historical" (1973-1975 and 1988-1990) and "modern" (2005-2007 and 2015-2017). There was a significant increase in emergent thoracotomy, delayed thoracic operations, overall operative interventions, and pulmonary resections from the historical period to the modern era. There was a decline in cardiac injuries treated, whereas the number of injuries remained constant. Mortality was unchanged between the early and later periods. Operative treatment beyond tube thoracostomy was much more prevalent for noncardiac thoracic GSWs in the past two decades than in the prior decades, whereas the number of cardiac wounds treated decreased by half.

Perforation Of The Small Intestine Due To Thoracic Gunshot Injury

Gunshot wounds can cause life-threatening injuries because they are high-energy traumas. Even gunshot or rifle injuries to the penetrating extraperitoneal abdomen or chest wall can cause damage to the abdominal organs despite a robust peritoneum and diaphragm. There are two different injury mechanisms resulting from gunshot wounds. These are related to the ”crushing“ and ”stretching of the tissues. Penetration and permanent cavity effects are generally visible in injuries with projectiles. The other major impacts, especially the temporary cavity, are difficult to show and are not known. In high-kinetic energy injuries, the temporary cavity is the main cause of the major damage caused by the bullet. There are more dangerous and more insidious effects than all of these, which is to create damage to the vascular endothelium. In this case, the organ that feeds into this vein can no longer be fed and goes to necrosis. Delayed perforation of the colon may occur within 72 hours after trauma. Gunshot wounds can cause serious injury. The organs near the projectile can be injured. Caution should be exercised for the possibility of indirect ballistic injury away from the projectile direction. Monitoring and grading of these important injuries is very important in terms of mortality and morbidity. We aimed to present a 19-year-old patient who had bowel perforation after a thoracic gunshot wound.

Saved by the Bar: A Report of Bullet Deflection by Nuss Bar

This is the case of a 17-year-old male who was saved from a penetrating thoracic gunshot wound by the extra-thoracic segment of a Nuss bar, placed 7 months earlier for treatment of a pectus excavatum defect. We discuss the significance of non-penetrating thoracic trauma and the workup involved.

Reassessing the cardiac box: A comprehensive evaluation of the relationship between thoracic gunshot wounds and cardiac injury.

High-energy missiles can cause cardiac injury regardless of entrance site. This study assesses the adequacy of the anatomic borders of the current "cardiac box" to predict cardiac injury. Retrospective autopsy review was performed to identify patients with penetrating torso gunshot wounds (GSWs) 2011 to 2013. Using a circumferential grid system around the thorax, logistic regression analysis was performed to detect differences in rates of cardiac injury from entrance/exit wounds in the "cardiac box" versus the same for entrance/exit wounds outside the box. Analysis was repeated to identify regions to compare risk of cardiac injury between the current cardiac box and other regions of the thorax. Over the study period, 263 patients (89% men; mean age, 34 years; median injuries/person, 2) sustained 735 wounds (80% GSWs), and 239 patients with 620 GSWs were identified for study. Of these, 95 (34%) injured the heart. Of the 257 GSWs entering the cardiac box, 31% caused cardiac injury, whereas 21% GSWs outside the cardiac box (n = 67) penetrated the heart, suggesting that the current "cardiac box" is a poor predictor of cardiac injury relative to the thoracic non-"cardiac box" regions (relative risk [RR], 0.96; p = 0.82). The regions from the anterior to posterior midline of the left thorax provided the highest positive predictive value (41%) with high sensitivity (90%) while minimizing false-positives, making this region the most statistically significant discriminator of cardiac injury (RR, 2.9; p = 0.01). For GSWs, the current cardiac box is inadequate to discriminate whether a GSW will cause a cardiac injury. As expected, entrance wounds nearest to the heart are the most likely to result in cardiac injury, but, from a clinical standpoint, it is best to think outside the "box" for GSWs to the thorax. Therapeutic/care management, level IV.

Femoral artery embolism of bullet after thoracic gunshot wound

Femoral artery embolism of bullet after thoracic gunshot wound

Thoracic Gunshot Wound: A Report of 3 Cases and Review of Management

Thoracic Gunshot Wound: A Report of 3 Cases and Review of Management Thoracic gunshot injury may have variable presentation and the treatment plan differs from case to case. The risk of injury to heart, major blood vessels and the lungs should be evaluated in every patient with rapid clinical examination and basic monitoring and surgery should be considered as early as possible whenever indicated. The authors present three cases of thoracic gunshot injury with three different presentations, one with vascular injury, one with parenchymal injury and one case with fortunately no life threatening internal injury. The first case, a 52 year male patient presented with thoracic gunshot with hemothorax and the bullet trajectory passed very near to the vital structures without injuring them. The second case presented with 2 hours history of thoracic gunshot wound with severe hemodynamic instability. Surgical exploration revealed an arterial bleeding from within the left lung. The third case presented with post gunshot open pneumothorax. All three cases were managed successfully with resuscitation and thoracotomy. Preoperative on table fluoroscopy was used for localization of the bullet.

The Acute Management of a Thoracic Aorta Gunshot Wound and Missile Embolization with Endovascular Stent Grafting and Open Missile Retrieval

The Acute Management of a Thoracic Aorta Gunshot Wound and Missile Embolization with Endovascular Stent Grafting and Open Missile Retrieval

A case of gunshot wound presenting with atypical cardiorespiratory findings

It is well known that a significant increase has occurred in the incidence of thoracic gunshot wounds in children over the last 15 years. Gunshot wounds have been defined as an a€A“epidemica€, a€A“a diseasea€, and a€A“a preventable public health problema€ all over the world. Gunshot wounds in children lead to more lethal or morbid outcomes due to the relatively small area in which their vital organs exist. Gunshot wounds are an increasingly more important problem in present communities with both their morbidities leading to significant impairment in quality of life and significant mortality. In this article, a case with various clinical outcomes following a gunshot wound is presented.

Aortic bullet embolization revealed by peripheral ischemia after a thoracic gunshot wound

We present the case of a 21-year-old male who came to the emergency ward for a thorax bullet wound. At our first check-up, the computed tomography (CT)-scan showed a pulmonary contusion, a hemothorax and a suspicious image of a thoracic aortic wound. The patient was stable, but soon after admission a distal ischemic syndrome appeared which revealed the emboli of the projectile. We removed it and a stent graft was implanted into the thoracic aorta. We report our experience of the treatment and the mechanisms that explain how such a wound did not kill the patient.

Thoracic Gunshot Wounds: Alterations to Pulmonary Function and Respiratory Muscle Strength

The impact on respiratory function of gunshot injuries to the chest is unknown. The objective is to assess pulmonary function and respiratory muscle strength (RMS) in patients who have recently sustained an isolated gunshot injury to the chest. After institutional review board approval, patients with isolated gunshot injuries to the chest were prospectively identified. Study patients underwent pulmonary function testing and an assessment of RMS and gas exchange. Ten male patients sustaining an isolated pulmonary gunshot wound were prospectively enrolled with a mean age of 29 years ± 10 years and mean Injury Severity Score of 15 ± 5. All patients had an associated pneumothorax (n = 1), hemothorax (n = 4), or a combination of both (n = 5). After removal of all thoracostomy tubes and before discharge [7.4 days ± 5.4 days (range, 2-21 days)], patients underwent respiratory function testing. Lung volume subdivisions were reduced by 25% to 60% of predicted and diffusion capacity by 37% with preservation of the normal ratio of diffusion capacity to alveolar volume. In the six subjects able to perform spirometry in seated and supine postures, forced vital capacity decreased by 20% when changing posture (p = 0.046). Arterial blood gas analysis showed significant reduction in the P(AO)₂/FIO₂ ratio (or increase in AaDO₂). Maximal respiratory pressures were severely reduced from predicted values, the maximal inspiratory pressure by 60% and the maximal expiratory pressure by 78%. Lung volumes and RMS are decreased moderately to severely in patients who have sustained an isolated pulmonary gunshot wound. Expiratory muscle force generation is more severely affected than inspiratory muscle force. Further investigation of the long-term impact of these injuries on respiratory function is warranted.

Staring Back Down the Barrel: The Evolution of the Treatment of Thoracic Gunshot Wounds from the Discovery of Gunpowder to World War II

The β-hairpin antimicrobial peptides arenicins from marine polychaeta Arenicola marina exhibit a broad spectrum of antimicrobial activity and high cytotoxicity. In this study the biological activities of arenicin-1 and its therapeutically valuable analog Ar-1[V8R] were investigated. The peptide Ar-1[V8R] displays significantly reduced cytotoxicity against mammalian cells relative to the wild-type arenicin-1. At the same time, both peptides exhibit similar antibacterial activities and kinetics of bacterial membrane permeabilization. Comparative NMR analysis of the peptides spatial structures in water and membrane-mimicking environment showed that Ar-1[V8R] in contrast to arenicin has significantly lower dimerization propensity. Thus, dimerization of the antimicrobial peptide arenicin plays a key role in the cytotoxicity but not in the antibacterial activity.